Shared governance

Abstract

I was delighted to read about the theoretical foundation of nursing shared governance in “A theory-based approach to nursing shared governance” (Joseph and Bogue, 2016Joseph M.L. Bogue R.J. A theory-based approach to nursing shared governance.Nursing Outlook. 2016; 64: 339-351Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar). Academics rarely publish in this sphere, and I am hopeful that others will soon follow. However, I wanted to offer more accurate representations of my work in shared governance over the last 30 years, particularly in regard to the Index of Professional Nursing Governance (IPNG) and the Index of Professional Governance, which have become the standard instruments for measuring shared governance. The authors cite my description of shared governance as structures and processes by which organizational participants direct, control, and regulate the many goal-oriented efforts of other members (Hess, 2011Hess Jr., R.G. Slicing and dicing shared governance: In and around the numbers.Nursing Administrative Quarterly. 2011; 35: 235-241Crossref PubMed Scopus (37) Google Scholar). That is my definition of governance, a multidimensional concept that encompasses traditional, shared, and self-governance. In the same paragraph, I define shared governance as an “organizational innovation that legitimizes health care professionals' decision-making control over their practice, while extending their influence to administrative areas previously controlled by managers” (Hess, 2011Hess Jr., R.G. Slicing and dicing shared governance: In and around the numbers.Nursing Administrative Quarterly. 2011; 35: 235-241Crossref PubMed Scopus (37) Google Scholar, p. 235). The authors allude to two shortcomings in the IPNG, which they rightly claim is the most widely used measure for nursing shared governance. First, that it is “lengthy… and therefore, burdensome” (p. 340), citing a previous study, which reported that “the response rate for [their own] survey was low but not surprisingly so in the environment it was given” (Lamoureux et al., 2014Lamoureux J. Judkins-Cohn T. Buteo R. McCue V. Garcia F. Measuring perceptions of shared governance in clinical practice: Psychometric testing of the RN-focused Index of Professional Nursing Governance (IPNG).Journal of Research in Nursing. 2014; 19: 69-87Crossref Scopus (14) Google Scholar). If the authors would have contacted me, I could have told them that completion of the IPNG, validated by more than 20 years of thousands of participants, takes 20 minutes to yield 86 separate touchstones for strategic planning and implementation of shared governance. Although its extremely high reliability would allow shorter instruments, I have resisted because of the strategic data that it yields for administrative intervention. The second shortcoming deemed more important by the authors is that the instruments are based on traditional governance, allegedly a poor fit for direct care nurses in acute care settings. Rather, I believe the IPNG is a reality-based fit and an appropriate educational tool for nurses because they must still navigate bureaucracies to deliver care. Until institutions become awash with the caring we espouse as a profession, we must be adept at engaging other professionals, including administrators, on their own terms and turf, however alien. As a nurse, I am proud to say our shared governance models have made us effective organizational players. The authors conclude that we should be cautious in linking outcomes to shared governance because it is vague and bereft of operational definitions. The IPNG provides 86 items that together operationally define shared governance. It is like teaching the test. The items are culled from rigorous research with administrators and direct care nurses in the know. The language was updated a few years ago by an international, multigenerational group of practicing nurses. What better way to define and measure shared governance than using an inclusive list of items vetted by providers?